Santos Simione operates health clinics in Mozambique, which has one of the highest rates of HIV in the world, with one in eight adults infected. Its poverty rate is about 45 percent. The illiteracy rate is 47 percent in the sub-Saharan nation, which emerged from Portuguese colonial rule in the 1970s and then fell into a protracted civil war that only ended in 1992. Simione’s Mozambican Association for Family Development, or AMODEFA, provides services that include family planning, HIV counseling and other medical assistance. “If it wasn’t for Amodefa’s visits, I wouldn’t be here,” an HIV-positive mother told the Guardian last year.

Simione was recently in Washington, D.C., but it was not to receive an award for his public health work. Rather, it was to help release a new report from the Center for Health and Gender Equity (CHANGE) that details how the Trump administration’s tethering of foreign aid to a strict pro-life agenda has harmed efforts to curb AIDS and other diseases around the world. Simione, for example, has had to close half of his 20 youth clinics in Mozambique because he is a supporter of abortion rights and refused to comply with the requirements the administration put in place after taking office last year.

The Mexico City policy was canceled by President Bill Clinton, but then restored by President George W. Bush, only to be canceled again by President Barack Obama. But according to the new CHANGE report, Trump’s version of the Mexico City policy — now officially titled Protecting Life in Global Health Assistance — is the most onerous yet.

That policy was spelled out in a memorandum issued three days after Trump’s inauguration. It instructed his incoming Secretary of State, Rex W. Tillerson, “to implement a plan to extend the requirements of the reinstated Memorandum to global health assistance furnished by all departments or agencies.” The application of the Mexico City policy to anything involving public health abroad, not just family planning, is “an unprecedented expansion of the policy,” CHANGE argues in its report, estimating that some $8.8 billion in foreign aid is predicated on organizations’ asserting that neither they nor their subcontractors provide abortion services.

“Basically, if you’re doing any health activities overseas as a non-U.S. organization, you are impacted by this policy,” said CHANGE president Serra Sippel at the report’s release at the National Press Club on Tuesday. (American nongovernmental organizations are exempt from the Mexico City policy.)

Simione was among the activists in Mozambique pushing for abortion to be made legal there, and laws surrounding pregnancy termination were in fact liberalized in 2015. He estimates that, because of his refusal to comply with the Mexico City stipulations, he has lost two-thirds of his funding. “Prescribing Chaos” uses AMODEFA’s clinic in the coastal district of Xai-Xai as a case study. It finds that between July and September of 2017, AMODEFA tested 5,981 young women and girls for HIV/AIDS. But then, after it refused to comply with the Mexico City policy and lost its funding, it was only able to test 671 in the final three months of the calendar year.

Protesters rallying in support of women’s health programs and against the White House global gag rule, March 8, 2017. (Photo: Justin Sullivan/Getty Images)

“To limit access to abortion does not stop abortion,” Simione explained during an address Tuesday at the National Press Club. In fact, research findings published in 2011 by Kelly M. Jones of the International Food Policy Research Institute found the opposite. Focusing on the West African nation of Ghana during the George W. Bush presidency, when the Mexico City policy was in place, Jones discovered “no evidence that any demographic group reduces the use of abortion as a result of the policy. On the contrary, rural women significantly increase abortions.” CHANGE estimates that between 2017 and 2020, the reinstatement of the Mexico City policy will result in 6.5 million unwanted pregnancies, 2.1 million unsafe abortions and 21,700 maternal deaths.

But because abortion is an animating political issue for the right, the policy is back in place, and it’s likely to remain so while Trump or any other Republican is president. That prospect infuriated many of the attendees at Tuesday’s event. Among those present was Edinah Masiyiwa, who runs the Women’s Action Group in Zimbabwe. Masiyiwa explained that Zimbabwe was considering implementing a comprehensive sex education policy, a crucial potential development in a nation where child marriage is a problem and the adult HIV/AIDS rate is 13.5 percent, the sixth-highest in the world. But Zimbabwe, which is subject to the Mexico City policy, would be prevented from including abortion in the curriculum. That would either kill the plan for comprehensive sex education or significantly shorten the reach of any curriculum that does come to pass.

“It’s a deadly policy,” Masiyiwa said. “It should be stopped.”

An African woman shows her skin condition to her visiting friend and caregiver in a small village in Mozambique, August 2012. The caregiver works for a charity that aims to increase HIV awareness and to support people affected by the disease and poverty. (Photo: In Pictures Ltd./Corbis via Getty Images)